How many calories should an anorexic eat to recover? Well, in order to answer this question, you will have to understand what anorexia is, how it impacts a person’s health and how to recover from it. When you have anorexia, it is essential that you consume adequate calories to regain a healthy weight. In addition to eating healthy foods, you want to ensure that the number of calories you eat is large enough to prevent further loses in weight.
Health experts always warn us about the importance of eating healthy. Studies show that eating healthy food has several health benefits, including decreased risk of heart disease, stroke and cancer, as well as helping to control weight. However, many people cannot afford to eat all organic foods. The expensive price of healthy food may be the first reason preventing people from choosing a healthier diet. So what should we do?
How Many Calories Should An Anorexic Eat To Recover
Anorexia, formally known as anorexia nervosa, is an eating disorder. People with anorexia limit the number of calories and the types of food they eat. Eventually, they lose weight or cannot maintain an appropriate body weight based on their height, age, stature and physical health. They may exercise compulsively and/or purge the food they eat through intentional vomiting and/or misuse of laxatives.
Individuals with anorexia also have a distorted self-image of their body and have an intense fear of gaining weight.
Anorexia is a serious condition that requires treatment. Extreme weight loss in people with anorexia can lead to malnutrition, dangerous health problems and even death.
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Who does anorexia affect?
Anorexia can occur in people of any age, sex, gender, race, gender, ethnicity, sexual orientation and economic status and individuals of all body weights, shapes and sizes. Anorexia most commonly affects adolescents and young adult women, although it also occurs in men and is increasing in numbers in children and older adults.
How common is anorexia?
Eating disorders affect at least 9% of the worldwide population, and anorexia affects approximately 1% to 2% of the population. It affects 0.3% of adolescents.
What is the difference between anorexia and bulimia?
Anorexia nervosa and bulimia nervosa are both eating disorders. They can have similar symptoms, such as distorted body image and an intense fear of gaining weight. The difference is that they have different food-related behaviors.
People who have anorexia severely reduce their calorie intake and/or purge to lose weight. People who have bulimia eat an excessive amount of food in a short period of time (binge eating) followed by certain behaviors to prevent weight gain. Such behaviors include:
- Intentional (self-induced) vomiting.
- Misuse of medications such as laxatives or thyroid hormones.
- Fasting or exercising excessively.
People with bulimia usually maintain their weight at optimal or slightly above optimal levels whereas people with anorexia typically have a body mass index (BMI) that is below 18.45 kg/m2 (kilogram per square meter).
Restoring Nutritional Health in Anorexia Nervosa
The malnutrition that accompanies anorexia nervosa can negatively impact all systems of the body. Therefore, restoration of weight and nutritional health is an essential component of treatment for anorexia nervosa.
Restoring a body malnourished by anorexia nervosa may take many months or even years. Patients with anorexia nervosa should generally be under the care of a treatment team, which commonly includes a medical doctor, a registered dietitian nutritionist, a psychotherapist, and a psychiatrist.
Anyone beginning nutritional rehabilitation must be aware of the potentially fatal refeeding syndrome. This article begins with the necessary precautions to avoid this potential side-effect. It then offers strategies for outpatient nutritional rehabilitation, suggested meal plans, additional weight gain strategies, and suggestions for overcoming common challenges to recovery.
Refeeding Syndrome
One potential risk to be considered before beginning nutritional rehabilitation is refeeding syndrome.
Refeeding syndrome is caused by the rapid refeeding of someone in a state of starvation, usually chronic, and it may be fatal. It is characterized by electrolyte and fluid shifts associated with metabolic abnormalities in malnourished patients undergoing nutritional rehabilitation.
What is Refeeding Syndrome?
How could finally eating after a period of starvation possibly be harmful to the body? Biochemistry tells us that ketone bodies and free fatty acids from the breakdown (catabolism) of muscle and adipose tissue replace glucose as a major energy source in starvation.
During refeeding, there is a shift from fat to carbohydrate metabolism. The resulting insulin released from the pancreas increases cellular uptake of glucose, phosphate, potassium, magnesium, sodium, and water. The body also shifts into a building (anabolic) state of protein synthesis, which requires more nutrient uptake into the cells.
The body then is at risk for not having enough of these vital nutrients in the bloodstream. Clinical consequences may include irregular heart rate, congestive heart failure, respiratory failure, coma, seizures, skeletal-muscle weakness, loss of control of body movements, and neurological symptoms.
Preventing Refeeding Syndrome
To avoid refeeding syndrome, levels of phosphorus, magnesium, potassium, calcium, and thiamin must be monitored for the first 5 days and every other day for several weeks. Electrocardiogram (EKG) should also be performed. Strict medical oversight is required.
The National Institute for Health and Clinical Excellence Criteria for Patients advises that there is a significant risk for refeeding syndrome if your starting point is 1,000 or fewer calories per day.
Refeeding syndrome risk increases greatly with patients who have one of the following indicators:
- BMI: Body mass index of less than 16
- Electrolyte imbalances: Low levels of potassium, phosphate, and/or magnesium before refeeding
- Recent intake: Little or no nutritional intake for more than 10 days
- Weight loss: Losing more than 15% of body weight in the past 3–8 months
Patients with two or more of the following indicators are also at higher risk of refeeding syndrome:
- BMI: Body mass index of less than 18.5
- History: Alcohol misuse or drugs, including insulin, chemotherapy, antacids or diuretics
- Recent intake: Little or no nutritional intake for more than 5 days
- Weight loss: Losing more than 10% of body weight in the past 3–6 months
Body Mass Index (BMI) is a dated, biased measure that doesn’t account for several factors, such as body composition, ethnicity, race, gender, and age. Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.
Additional guidance regarding the prevention of refeeding syndrome is available via the Academy for Eating Disorders’ Guide to Medical Management. Under these conditions, nutritional restoration must go slowly to avoid potential refeeding syndrome.
A medical team is necessary including a medical doctor and a Registered Dietitian Nutritionist (RDN) to calculate, monitor, and increase daily food and fluid intake as well as monitor plasma and urinary electrolytes, plasma glucose, vital functions, and cardiac rhythm before and during refeeding.
The remainder of this article is directed towards those who are not at risk for refeeding syndrome and have been medically cleared to begin or continue nutritional rehabilitation on an outpatient basis.
Overcoming Weight Restoration Challenges
Since a primary symptom of the disorder is a dietary restriction, what patient with anorexia will willingly eat more?
Resistance is common and calls for direct support from loved ones and a team of professionals who can help hold patients accountable to meal plans and weight gain as well as challenge the eating disorder mindset and encourage consumption of fear foods on a daily basis.
Vegetarian, low fat, low carb, and non-dairy diets should be discouraged (unless a diagnosed allergy) as they often are a symptom of the disorder and not based on legitimate health concerns.
Delayed gastric emptying or gastroparesis is common with anorexia nervosa and can contribute to early fullness and bloating. This further complicates the renourishing process as eating the required increased intake may be physically uncomfortable.
Frequent nutrient-dense meals and snacks that allow for smaller portions without sacrificing calorie content is the key to overcoming this hurdle. Eating disorder recovery teams can help support renourishing’s physical side effects as well as the psychological resistance to such aspects of recovery.
Teams usually include a medical doctor, registered dietitian nutritionist, psychotherapist, and psychiatrist. When searching and building outpatient teams, it is advisable to make sure practitioners have expertise in the treatment of eating disorders.
Allowing a loved one to help with accountability and provide recovery support can be extremely powerful in recovery. Family-Based Treatment (FBT or Maudsley) is an evidence-based model designating parents as the primary support for refeeding of children and adolescents with anorexia nervosa.
Calories for Eating Disorder Recovery
Counting calories in eating disorder recovery can seem to contradict. Shouldn’t we learn to listen to our bodies instead of worrying about calories? Most likely, obsessing about calories was a major part of our eating disorder anyway. We should eliminate that bad habit instead! So what’s up with that counting BS?!
I started my recovery with intuitive eating after I read the e-book “Recover From Eating Disorders” by Nina V. It helped me to let go of the “good and bad foods” mindset. To listen to my body and let go of rules and restrictions. This was a major step towards recovery.
But in intuitive eating they tell you to “be mindful”, “do not eat too much”, “stop eating at number 6” and so forth. I tried to do that, but it was not possible. I was hungry like a werewolf. I wanted to eat a whole potful of pasta, not just one plate.
The thing is that I had NO idea what I was doing or what was required for proper recovery. I did not know how many calories were needed or that bingeing in recovery is actually extreme hunger (and normal!) or that I probably should have stopped running 1 hour every day.
For me, the beginning of recovery was riddled with trial and error. I learned as I went through it. I relapsed a lot, I went back to “clean eating”, did some intermittent fasting to “help the healing” and exercised because “it’s sooo healthy for you”, yeah, right…
But after a while, I learned about the MinnieMaud calorie guidelines. Why eating a proper amount of calories helps to heal your body and restore normal hunger signals. Why extreme hunger in recovery is normal and why stopping all exercise is important. MinnieMaud was a good sense of direction in my recovery, something I could rely on, rather than just go through it blindfolded and just hope for the best.
After learning about MinnieMaud everything sped up. I did not follow the guidelines the entire length of recovery, but about a month or so, until I learned that whatever amount I am hungry for, whether it was physical or just “mental” hunger was ok to eat.
I learned that whatever amount I am hungry for, whether it was physical or just “mental” hunger was ok to eat!
MinnieMaud Guidelines are science-based guidelines for recovery from restrictive eating disorders that have been developed on Your Eatopia website. The “Minnie” refers to the Minnesota Starvation Experiment and the “Maud” refers to the only evidence-based treatment program for eating disorders out there at the moment: Family Based Treatment, also known as the Maudsley protocol.
The guidelines are actually set at what energy-balanced, non-eating-disordered people normally eat to maintain their health and weight. That means that the minimum intake guidelines are what you can expect to eat both during and post-recovery. And remember, the guidelines also mean eating more when extreme hunger strikes, stopping all exercise and resting as much as possible.
And please keep in mind that these are the MINIMUMS what you should eat, it is normal to eat way more than that. Remember, no restriction!
I can say from personal experience that some days in recovery you will feel ravenous and you may consume way more calories than that. Some people consume 5000-10,000 calories a day in recovery. It all depends on your personal eating disorder background and there is no wrong number of calories you can consume! In time, your eating and episodes of extreme hunger will normalize and you will be eating more close to 2500-3000 calories a day.
Why can weight gain be important for people with eating disorders?
It cannot be ignored that gaining weight after restricting food intake for an extended period – and losing weight as a result – can be crucial to saving a life. This process is also known as weight restoration as it allows the body to reach a point of body weight stability and a weight that is healthy and maintainable for the individual. This might follow an ED such as anorexia nervosa, bulimia nervosa, or binge eating disorder (BED).
Specialist eating disorder dietitian Lisa Waldron explains that there’s evidence showing low weight can have a range of effects on physical and mental health, such as:
- Low mood.
- Increased anxiety.
- Brain shrinkage – which can impact cognitive flexibility.
- Reduced hormone production – which can impact fertility.
- Weakened bone health.
- Struggles making decisions and being spontaneous.
- Irritability or trouble managing emotions.
Gaining weight as you pursue treatment and tackle the root of your struggles can also improve your relationship with food. As you gain weight and become less controlling and restrictive over your calorie intake, the rest of your life can flourish as a result. Successful recovery can help you to eat without micromanaging every bite and no longer giving food choices a moral value – viewing low-calorie foods as ‘good’ and high-calorie foods as ‘bad’.
Why might gaining weight be difficult if you’ve had an eating disorder?
At the root of the majority of eating disorders is a penchant for control – whether that’s control over food intake or implementing rigid routines in other aspects of life, like exercise. Therefore, the reality of having to gain weight and giving up this control can be scary.
Other difficulties you might encounter include:
- Fear that weight restoration may not stop.
- Fear that restoring weight will result in others thinking you are recovered when you are still struggling.
- Struggles maintaining a meal plan and regular eating habits.
- Increased feelings of self-loathing and insecurity as you settle into a growing body.
- Trouble finding healthier coping mechanisms for challenging situations that don’t involve food.
There can also be physical challenges to weight restoration, which Waldron highlights as:
- Early satiety – feeling full halfway through meals.
- Gut issues – bloating, pain, constipation/diarrhoea.
- Weight restoration occurring around the middle – stomach area – with no control over where it will sit on the body.
- Menstruation restarting if it stopped, which is not always welcome.
Waldron adds that an eating disorder can be aggravated by the need to gain weight if the illness has consistently reinforced the idea that you need to do the opposite for so long.
“It’s understandable why people become distressed during weight restoration, since they are challenging their eating disorder. Therefore, it’s important to work with a therapist and dietitian to understand how to manage difficult emotions. Professionals may work on developing skills to manage anxiety, challenge intrusive thoughts, and focus on the reasons for recovery.”
Eating alongside a family member or friend for support in the early stages can help, as can writing in a journal to reflect on your feelings.
What might a weight restoration plan look like?
“Everyone’s weight restoration plan will be unique since it is designed around the individual and their needs. This plan should be agreed with a dietitian, with the input of a therapist, as they are often required to work through mental and emotional barriers,” says Waldron.
She explains that a dietitian will do a nutritional assessment and agree on a plan based on their patient’s needs. To ensure you restore weight safely, you should follow the advice of a dietitian who can monitor and review appropriately.
While the mere thought of a weight restoration process can feel daunting, you should remember that an eating plan will likely increase in stages. This can help you to adjust and is also due to the risk of refeeding syndrome, a serious condition caused by introducing nutrition to a malnourished person. There’s a risk of a fatal shift in fluids and electrolytes, which may lead to clinical complications. Calories need to be increased incrementally under a doctor’s supervision.
“Dietitians typically encourage people to use food for weight gain by increasing portion size or increasing the frequency of meals or snacks, or increasing the nutrient density of food eaten,” says Waldron, adding that shakes are not typically recommended, as:
“We like people to use food because it offers the experience of the whole eating process, including chewing and swallowing.”
However, oral nutritional supplements can occasionally be used in the refeeding process, since many people with eating disorders can be malnourished. Therefore, along with the guidance of a professional, in some cases, shakes and supplements can be invaluable. This might be especially true in early recovery, where a person struggles to get enough calories from food alone.
Importance Of Eating Healthy
People often think of healthy eating as dieting. This is not true. Eating healthy is not just about losing weight, it’s about feeling better both physically and mentally.
Eating healthy is about balance and making sure that your body is getting the necessary nutrients it needs to function properly. Healthy eating habits require that people eat fruits, vegetables, whole grains, fats, proteins, and starches. Keep in mind that healthy eating requires that you’re mindful of what you eat and drink, but also how you prepare it. For best results, individuals should avoid fried or processed foods, as well as foods high in added sugars and salts.
Top 5 Benefits of Healthy Eating
1.Weight Loss
One of the main reasons people eat a healthy diet is to maintain a healthy weight or to lose weight. A healthy weight has a plethora of benefits on its own, but we won’t get into that here.
2.Heart Health
Even if you’re young, you should think about your heart health, especially considering that as many as 92.1 million people in the U.S. have some type of cardiovascular disease. Healthy eating habits can improve your heart health and common prevent heart diseases.
3.Strong bones and teeth
If you pay close attention, you might notice that a lot of elderly individuals use dentures in order to eat and talk properly. A healthy diet can help individuals make sure they have strong teeth and bones now and, in the future, thus preventing teeth decay and osteoporosis.
4.Better mood and energy levels
“You are what you eat.” If you eat a healthy, balanced diet, you will feel better and more energized. Furthermore, if you eat property, then it means your body is getting all of the nutrients it needs to function properly, which will improve your energy levels. Avoid sugary foods and drinks to prevent sugar highs and crashes.
5.Improved memory and brain health
Eating healthy increases blood flow to the brain, which help prevent brain diseases like Alzheimer’s, dementia, and cognitive decline.